TTI Impact

Choose a state to learn more

  • Alabama


    ADMH worked on developing a crisis communication system that includes new crisis diversion centers, rural crisis care projects, and the Alabama Stepping Up Initiative which provides access to care in addition to advocacy for the passage of state funding for the 988 crisis line.

  • Alaska


    Building Crisis Services that Serve Under-Resourced Minority Communities: Alaska worked on increasing tribal citizen utilization of crisis call services, enhancing tribal input in the development and expansion of crisis line services, and increasing the capacity of the 988 Suicide and Crisis Lifeline accredited call center to offer culturally grounded crisis services and coordinate referrals to Tribal Health Organizations.

    Workforce: Alaska  worked on addressing workforce development by increasing training for peer support specialists in crisis services to include youth/family navigators, and to develop universal crisis intervention trainings for paraprofessionals and professionals in the crisis system.

  • American Samoa


    Crisis and Community Trauma: American Samoa  worked on coordinating the integration of trauma informed care across the territory’s crisis response service delivery system and in the community through collaboration with key stakeholders and the development of peer support services to engage any individual, including individuals with a serious mental illness or serious emotional disturbance, experiencing trauma/crisis.

  • Arizona


    Arizona worked to increase self-management of chronic illnesses among the Arizona peer-based workforce  and their family members (with focus on population with SMI). They also created the process and mechanisms to identify and refer peers into workshops and an educational module to train providers in recruitment and referral.

  • Arkansas


    Building Crisis Services that Serve Under-Resourced Minority Communities: Arkansas followed up on their 2022 TTI focusing on individuals with a serious mental illness or serious emotional disturbance who self-identify as LGBTQ+. Initiatives included the Arkansas Inclusive Network/Focus group, professional training development for first responders/providers/law enforcement/educational professionals, and train-the-trainer programs. 


  • Colorado


    Workforce: Colorado focused on supporting the development of a Crisis Professional Core Curriculum, to be offered at no cost to individuals serving those in crisis throughout the state. The goal was to standardize training and supervision for all crisis workers, regardless of background and prior education.

  • Commonwealth of the Northern Mariana Islands (CNMI)


    Facilitating Timely Access to Community-Based Mental Health Services: CNMI worked on planning, implementing, and evaluating Mobile Crisis Response services as part of comprehensive CNMI CHCC Behavioral Health Crisis Care services.

    Facilitating Timely Access to Community-Based Mental Health Services: CNMI worked on developing a Professional Pathways Project to increase the number of CNMI Behavioral Health certified professionals and to implement a CNMI Behavioral Health Aide Program.

  • Connecticut


    Workforce: Connecticut utilized funds to address notable data collection voids and to investigate new and innovative initiatives to assess the effectiveness of current crisis-related services. The state worked on this through data collection initiatives that inform the improvement and expansion of their crisis services and to examine the viability of a regional crisis response structure designed to expand the continuum of care and to encourage coalition-building and collaboration among community partners.

  • Delaware


    Building Crisis Services that Serve Under-Resourced Minority Communities: Delaware  worked to strengthen the capacity for their behavioral health crisis continuum to serve neurodivergent individuals, especially those with intellectual and developmental disabilities (IDD) or dual IDD and behavioral health conditions. Initiatives included collaborative learning system mapping, developing training curriculums and public resources, and partnering with first responder communities.

    Workforce: Delaware  worked to expand the peer recovery specialist workforce pipeline for their behavioral health crisis services. Activities included reviewing current curriculum and certification pathways, growing the peer recovery specialist workforce pipeline, creating professional development pathways, and developing a youth and family crisis peer training program.

  • Florida


    DCF, through culturally appropriate, evidence-based, and best practices, employed Forensic Peer Specialists in the new Community Forensic Liaison (CFL) Team to reduce the health and social disparities for justice-involved individuals with mental illnesses, thereby improving service access and outcomes, and strengthen collaboration between the mental health and law enforcement/criminal justice systems. DCF, using the Sequential Intercept Model, employed Forensic Peer Specialists to collaborate with jails to assess and coordinate treatment for individuals within the jails and upon reentry in their efforts to reduce the health and social disparities for justice-involved individuals with mental illnesses.

  • Georgia


    Building Crisis Services that Serve Under-Resourced Minority Communities/Workforce: Georgia  worked to create a Crisis System Learning Collaborative with two cohorts that provides training, improves communication and relationships across the state-funded crisis system, and creates a mechanism for DBHDD to get feedback from its provider network. The two are Cultural and Linguistic Competence and Improving Inpatient Diversion.

  • Guam


    Workforce: Guam worked to support the following goals: Provide training to behavioral health staff providing services, such as crisis response, provide virtual professional development opportunities for more immediate means of accessing information, education, and trends in behavioral health, and build on-demand professional development capacity for staff seeking to improve clinical and direct service practices to retain staff.

  • Hawaii


    Crisis and Community Trauma: Hawai’i worked to develop and implement a standard 3-part program curriculum for their mental health/substance use disorder workers statewide: introduction to trauma and how it impacts care, the role of cultural historical trauma and avenues to healing, and workforce support and trauma in individuals’ own lives, including secondary traumatic stress impacts providers. 


  • Idaho


    Idaho Psychiatric Bed and Seat Registry (IPBSR) grew and improved their crisis response system through expanded crisis call centers, mobile crisis teams, crisis stabilization centers, crisis respite, and inpatient beds across the state.

  • Illinois


    Developed and strengthened the use of Health Information Technology (HIT) in crisis prevention, intervention, and management. Collaborated with Northwestern University Center for Behavioral Intervention Technologies (CBITs) to refine and expand the use of a smartphone app which will help connect homeless youth, and potentially other populations, to services. Recruited and trained peer volunteers for the Crisis Text Line and/or other peer support services.

  • Indiana


    Building Crisis Services that Serve Under-Resourced Minority Communities: Indiana  worked to support activities to address mental health crises more equitably in Black youth across the state. This included focus groups that informed a report outlining recommendations for improving connectedness and quality of life for Hoosier Black youth. They worked to identify evidence-based and community/peer-based practices to contribute to the prevention and resolution of risk in Black youth communities in collaboration with the Mobile Response and Stabilization Services model for serving youth and families in crisis. 

    Workforce: Indiana  worked to launch a new communication and recruitment campaign around systemic behavioral health workforce development.


  • Iowa


    Facilitating Timely Access to Community-Based Mental Health Services: Iowa contracted with a consultant with proven experience in crisis system change to update and add to the landscape analysis done for IA's 2021 TTI project. They worked to conduct focused stakeholder engagement activities with individuals with lived experience of serious mental illness and co-occurring mental health and substance use disorders, and family members of children with serious emotional disturbance. They then made recommendations to IA HHS to reimagine IA's front door (with a focus on diversion) and develop processes to increase coordination between all components of the behavioral health system.  


  • Kansas


    Facilitating Timely Access to Community-Based Mental Health Services: Kansas worked to increase the collaboration between community services and the community mental health centers (CMHCs) through the training, collaboration, and strengthening of system development of the CMHC liaison staff.

    Workforce: Kansas worked to expand upon KDADS’s work previously started with the TTI 2022 funds. They worked to develop additional training to be made available to peer support professionals. Through the Peer Support Guild, KDADS intended to ensure that peer support professionals have access to trauma-informed, culturally, and linguistically competent training for special populations, including, but not limited to, veterans, individuals with intellectual and developmental disabilities, individuals who are BIPOC, and individuals who identify as LGBTQ+.


  • Kentucky


    Workforce: Kentucky focused on the Kentucky 988 Dedicated Call Taker Workforce Development Initiative which worked to design, implement and evaluate a workforce development package for statewide dissemination.

  • Louisiana


    Facilitating Timely Access to Community-Based Mental Health Services: Louisiana identified a national consultant to provide tailored technical assistance to LDH/OBH with the development and implementation of the Certified Community Behavioral Health Clinic (CCBHC) model as a Medicaid service that is specific to the culture and needs of Louisiana. The consultant worked to facilitate the establishment of a learning collaborative comprised of the five organizations awarded SAMHSA CCBHC grants and LDH/OBH.

  • Maine


    Maine worked with a group of consumers and providers to develop and implement a system of measures (in the form of a toolkit) focused on individual outcomes and recovery. The selected toolkit included four measurement instruments: the OQ, the Recovery Assessment Scale (RAS), the Data Infrastructure Grant Survey, and the LOCUS. The TTI award also assisted Maine in defining “recovery,” creating a draft of “Recovery Guidelines for Mental Health,” developing a recovery-focused clinical training module for the administration of the toolkit, testing Maine’s assumptions about whether the toolkit works to measure both individual and system outcomes, and create a training model for the implementation of the toolkit with providers and consumers.  

  • Maryland


    LGBTQ+: As part of their vision to develop a statewide integrated, comprehensive, culturally sensitive, and responsive behavioral health crisis system to serve and support all people, Maryland worked to launch LGBTQ-specific Training Modules.

    Workforce: Maryland’s initiative, Special Population Training Modules, served to ensure that Crisis Call Center Specialists have access to uniform training modules which address topics identified by Call Centers, including persons with lived experience, to ensure effective services are provided to children, youth, adults, older adults, and special populations.

  • Massachusetts


    Massachusetts worked to expand and enhance their Behavioral Health Network peer support program to assist with diversion via co-response and Community Clinical Response Team (CCRT) Clinicians, increase capacity through telehealth, and collaborate with law enforcement.

  • Michigan


    Michigan worked to demonstrate the effectiveness of Peer Support Specialists as health coaches and system navigators in Federally Qualified Health Centers (FQHC). Two areas of the state in both urban and rural settings that serve a significant population of persons with serious mental illness and/or co-occurring chronic conditions were chosen as pilot sites.

  • Minnesota


    Building Crisis Services that Serve Under-Resourced Minority Communities/Workforce: Minnesota  worked to support and strengthen workforce development trainings for 988 Lifeline centers and crisis service staff, including CCBHC crisis response staff. This included training on substance use and serious mental illness and serious emotional disturbance crisis response and intervention, as well as developing cultural humility and awareness training focused on American Indian communities in Minnesota in collaboration with tribal partners.


  • Mississippi


    Children and Adolescents: MS contacted the crisis line of the two 988 centers in the state, added three additional Open Up Mississippi chapters throughout the state, and continued to partner with Pine Belt Mental Healthcare resources to offer training to current Crisis Intervention Team officers on how to effectively connect to children and their families during crisis situations. NAMI partnered with parents/guardians of Open Up Mississippi council members in educating other parents regarding 988 and designating Open Up Mississippi members to consistently participate in DMH’s 988 Planning and Implementation Coalition to ensure children and families’ crisis needs were addressed.

    Workforce: MS hosted an in-person event to kick off the year of training and partnership among crisis system employees. The event aimed to address proactive planning, system collaboration, and best practices for crisis treatment. The selected consultant also provided virtual monthly trainings to crisis workers, relying heavily on individuals with lived experience for input on needed training topics.

  • Missouri


    DMH replicated an expansion of the successful Forensic Mobile Team, a community behavioral health program, to provide services in county jails that had no medical, psychiatric, or other services available.

  • Montana


    AMDD increased access to crisis and diversion services by researching and developing a Behavioral Health Crisis System Strategic Plan to inform the most relevant services in rural and frontier communities.

  • Nebraska


    Workforce: NE formalized a workforce development plan for supporting a Crisis Response Team (CRT). A team of stakeholders reviewed research and standard guidelines to make recommendations for curriculum development, training modalities, and skill verification. Outcomes included a plan for the development, implementation, and sustainability of CRT trainings. This included the development of a pilot cohort to complete the training and provide feedback.


  • Nevada


    Workforce: NV focused on two initiatives that aimed to enhance their mental health crisis system for adults in rural and frontier NV. These plans included providing incentives for current clinicians who administer crisis services in rural NV. This was intended to help with workforce retention and strengthen Nevada's current Immediate Mental Health CARE Team to improve crisis access for individuals in rural and frontier NV.

    Workforce: NV provided an annual stipend of $5,000 to 20 current board-approved clinical site supervisors who oversee post-graduate internships in rural and frontier counties in Nevada that were identified as mental health professional shortage areas starting in Quarter 4 of 2023.

  • New Hampshire


    Implemented statewide client-level outcome measures for adults and children/adolescents.

  • New Jersey


    Workforce: NJ built upon past TTI successes in enhancing and expanding the peer role. Activities included a mentorship program for peers working in their existing and emerging crisis settings as specified in the Best Practice Toolkit, a needs and gap assessment, development and delivery of advanced level training curricula, delivery of the training to experienced peers acquiring these additional competencies, assessment of the outcomes of this new educational endeavor, and a learning community of peers and their supervisors was established.

    Workforce: NJ developed a Crisis Services Community of Practice (CSCoP) that built a capable and resilient workforce that is well-trained in utilizing best practice approaches. The entity contracted to provide the CSCoP developed webinars and training series with subject matter experts and support listserv and networking amongst crisis service agencies.

  • New Mexico


    NM BHRN developed a Learning Collaborative to bring together and strengthen existing Crisis Triage Centers (CTCs) by bringing together service providers, their state Office of Peer Recovery and Engagement (OPRE), and law enforcement.

  • New York


    Building Crisis Services that Serve Under-Resourced Minority Communities: NY developed ECHOMH/intellectual and developmental disabilities (IDD), a project that was conceptualized to provide free tele-mentoring and didactic trainings for 988 counselors and mental health providers. These providers gave information regarding the treatment of individuals with co-occurring mental health challenges and IDD. The interdisciplinary hub team covered topics such as cultural and linguistic competency, interventions for minimally verbal individuals, considerations in crisis response for dually diagnosed youth and adults, and sensory integration issues contributing to behavioral crises.

    Facilitating Timely Access to Community-Based Mental Health Services: NY created an implementation plan for a mobile outreach unit. This mobile outreach unit provided crisis stabilization services in the East Flatbush neighborhood in Brooklyn, NY through a community-based planning process.

  • North Carolina


    Building Crisis Services that Serve Under-Resourced Minority Communities: NC supported a Needs Assessment, Resource Toolkit, and trainings for the deaf and hard-of-hearing community in the state.

    Building Crisis Services that Serve Under-Resourced Minority Communities: NC focused on improving the quality of emergency department (ED) data to strategically identify Behavioral Health holds. They did this by enhancing the quality of existing NC DETECT ED visit data and using ED data to perform a deep dive and investigate BH hold prevalence ED length of stay across the following dimensions: race, ethnicity, age, insurance coverage, geographic region, and rurality.

  • North Dakota


    Provided a pilot project to address the needs of transition-aged youth at risk. The TTI Project at North Central Human Service Center targeted transition-aged youth ages 14 -24 and built upon current transformation services as well as Bill 1044. This project collaborated and worked intensively with multiple community resources to provide the necessary support to youth in transition.

  • Ohio


    OMHAS expanded and enhanced treatment services within jails and increased reentry coordination for treatment and recovery supports for individuals with SMI to transition into the community through crisis prevention and training staff on trauma-informed care, access to psychiatric services, and access to supportive housing and transportation.

  • Oklahoma


    Building Crisis Services that Serve Under-Resourced Minority Communities: OK expanded upon their comprehensive crisis response system by engaging special populations: people with English as a second language, the deaf and hard of hearing community, and individuals living in OK tribal nations. ODMHSAS intended to develop a more inclusive 988 marketing campaign, strengthen warm handoffs between the Oklahoma Crisis Continuum of Care and Oklahoma tribal nations, and have sensory kits available to anyone interacting with mobile crisis teams.

    Workforce: OK built upon a partnership with local colleges and universities to support the growing number of RNs among existing staff seeking career advancement opportunities. ODMHSAS proposed to partner with local colleges and the Oklahoma State University (OSU) nursing program to pilot an LPN to RN training cohort. ODMHSAS identified local colleges for candidates to complete the requirements to enter the OSU LPN to RN pathway program.

  • Oregon


    Workforce: Oregon focused on the development and initiation of a consistent, streamlined, and centralized source: Behavioral Health Crisis Response Training Academy. For the workforce in phone crisis intervention, Community Based Mobile Crisis Intervention Services (CBMCIS), Mobile Response and Stabilization Services, and facility-based stabilization services in the community.

  • Palau


    Workforce: PW provided training to 100 providers on suicide prevention, intervention, and postvention. Subtopics included Training in Zero Suicide, mental health first aid (adult/youth), training in postvention, and training in psychosocial autopsy.

  • Pennsylvania


    Workforce: PA focused on utilizing PA's existing online learning system to provide crisis intervention workers with the necessary orientation and onboarding training. Had partnership with Temple University Harrisburg to create the modules necessary to meet both the pre-service and onboarding training requirements. Upon completion of these additional 22 hours of coursework, an individual will earn a certification as a Crisis Intervention Worker that will be valid for 2 years.

  • Puerto Rico


    ASSMCA expanded the services of the Crisis Peer Support Specialists to the Integrated Crisis Intervention program of the Linea PAS Hotline by assigning Certified Peer Support Specialists to provide services to crisis programs through the ASSMCA Mutual Support Center (MSC). ASSMCA integrated Crisis Peer Support Specialists, Recovery-Oriented Services, and their Offender Re-Entry Program to strengthen mental health treatment interventions at correctional facilities and in Forensic Psychiatric Hospitals by engaging individuals in peer-based recovery services, MH treatment, and development of personal skills.

  • Rhode Island


    Facilitating Timely Access to Community-Based Mental Health Services: RI increased access to higher levels of services via mobile crisis teams (MCTs) through MCT dispatch software concentrated in the 988-call center - thus connecting those that need more intense community-based services with our established CMHC and CCBHC partners.

  • South Carolina


    Children and Adolescents: SC collaborated with Sumter School District to address unmet needs and mental health concerns present among this population of youth. Project Connect piloted the use of Certified Peer Support Specialists, Mental Health Professionals, and Behavioral Interventionists working together in an alternative educational setting. They provided youth and parent peer support services, mentorship, care coordination, life skills training, and mental health services with connection to telepsychiatry and additional family supports.

    Children and Adolescents: SC enhanced the availability of early intervention for suicide and SMI in youth. Goals included providing early intervention and assessment services, including screening programs, to minors under the age of 18 and their caregivers as well as partnering with NAMI Piedmont TriCounty to develop a resource app to provide immediate support and resources to parents/caregivers of minors who were in crisis/at risk for suicide.

  • South Dakota


    DBH created a real-time, community-based, forensic service registry of comprehensive services including but not limited to residential crisis services, mobile crisis services, outpatient mental health, and substance use disorder services, residential mental health and substance use disorder services, and supported and recovery housing. They focused on diverting individuals with mental illness involved in the criminal justice system from incarceration to community-based treatment.

  • Tennessee


    Workforce: TN enhanced the crisis continuum by providing the latest evidence-based practices that promoted improving client/patient care as well as self-care concepts/skills for staff that directly provided crisis services. TN used DBT and Compassion Science to address workforce retention and development.

    Workforce: TN supported five peer program enhancements: public awareness and education about services and workforce opportunities, widespread dissemination of the CADRE system, stable training hours to ensure availability, scholarships to ensure access for potential qualifying peers and development of an employer toolkit including free ongoing training and technical assistance.


  • Texas


    Children and Adolescents: TX modified the Zero-Suicide framework for the juvenile justice system, implemented a learning collaborative for juvenile justice system stakeholders, and facilitated a train-the-trainer trainer series to increase suicide prevention trainings.

    Facilitating Timely Access to Community-Based Mental Health Services: TX established a learning collaborative for criminal justice, behavioral health, and community stakeholders to improve re-entry planning for people with serious mental illness who were exiting jail, including after forensic hospitalization.

  • Utah


    DSAMH, through Forensic Peer Support Specialists (FPSS), created a new initiative to expand diversion from incarceration into the existing crisis system. They established a specialized FPSS enhancement and practicum program and created a peer workforce to focus on individuals being diverted from incarceration due to behavioral health issues.

  • Vermont


    Building Crisis Services that Serve Under-Resourced Minority Communities: VT worked on co-sponsoring a pilot program to establish a proven model of mobile crisis intervention, Crisis Assistance Helping Out on the Streets (CAHOOTS), assist community-based mental health first response for crisis support and establishing a trauma-informed approach to alleviate pressures on other components of the system (police and EMS).

  • Virginia


    Furthered efforts to incorporate the use of Psychiatric Advanced Directives (ADs) into routine clinical practice throughout its system of care to promote individual self-determination, reduce coercion, and reduce the need for expensive crisis care including inpatient treatment and incarceration. They also provided much-needed cross-systems education about the behavioral health system to Virginia’s legal community, including judges, clerks, magistrates, commonwealth’s attorneys, and defense attorneys.

  • Washington


    Building Crisis Services that Serve Under-Resourced Minority Communities: WA worked onstanding up a Tribal Mobile Crisis Response (TMCR) team that will provide cultural-based crisis services to their tribal community. This includes supporting hiring a TMCR project manager, completing MCR training and identifying appropriate cultural adaptations needed, and developing a community map of services and workflows to serve individuals in crisis.

    Children and Adolescents: WA worked on purchasing participation in the MRSS Quality Learning Collaborative. Topics covered include leadership, financing, data, workforce development, capacity building, policy development, implementation barriers single point of access, community engagement, systems engagement, and service array.

  • Washington, D.C.


    DBH worked on expanding their existing service registry, EMResource, by engaging DC hospitals, crisis stabilization beds, inpatient and residential SUD services, and the Access HelpLine (AHL) to increase the capacity of tracking the full range of acute inpatient psychiatric services and reduce unnecessary wait times.

  • West Virginia


    Building Crisis Services that Serve Under-Resourced Minority Communities: WV worked on focusing on the guiding principles of building on existing engagement efforts while continuing outreach to new partners is critical for sustainable community engagement, and both require cultural humility. This request for intensive technical assistance is to support the subject matter expertise both within and external to WV for BBH to support culturally appropriate outreach and crisis service.

    Workforce: WV worked on focusing on the BBH Statewide Therapist Loan Repayment (STLR) project that focuses on recruitment and retention of the most needed MA-level early career behavioral health professionals, specific to WV. BBH collaborations with WV Medicaid which include a review of mental health crisis service funding mechanisms, and BBH partnerships with K-12 and higher education.

  • Wisconsin


    Workforce: WI worked on assessing the training needs of crisis-related positions across the state; identifying the core competencies required for these positions; developing or contracting for training on these core competencies; delivering the training on a pilot basis to select agencies; assessing the effectiveness of these trainings; making recommendations for scaling up the trainings so they can be provided state-wide and on an on-demand basis whether this be in person or virtually; and making recommendations for the sustainability of the initiative.

  • Wyoming


    Developed a statewide housing network across WY’s five regions designed to build a regional provider system for consumers and bolstered that effort with statewide SOAR training.

Years Participated in TTI:

Description of last TTI:

Why TTI is Unique

These flexible TTI funds are to be used to identify, adopt, and strengthen transformation initiatives and activities that can be implemented in the State, either through a new initiative or expansion of one already underway, and should focus on one or multiple phases of system change. TTI recipients are chosen on the following criteria:

  • Transformation readiness, demonstrated by examples of transformation initiatives already underway using State funds, Block grant funds, other identified public or private resources
  • Existing multi-agency collaboration on transformation initiatives.
  • Proposed initiatives rooted in systems change with the greatest quality impact.
  • Identification of other state resources and infrastructure which may leverage the TTI award funds for the proposed initiative.
  • Realistic timeframes, concrete activities, and measurable outcomes for the proposed initiative.